title: Ventriculoperitoneal shunt 30-day failure rate: a retrospective international cohort study.
abstract: BACKGROUND
  With the need for transparency of surgical results, 30-day outcome measures have become increasingly important. Ventriculoperitoneal (VP) shunt failure is a substantial burden to patients and health care systems.
  
  
  OBJECTIVE
  This study introduces the 30-day VP shunt failure rate as a possible barometer of surgical outcome and demonstrates its use in a national (United Kingdom [UK]) study and makes comparison with 2 published randomized, controlled trials (RCT).
  
  
  METHODS
  A cohort study of all (except 1) pediatric neurosurgical centers in the UK and Ireland. All new and revision VP shunt operations were recorded for 2008 and 2009. Both newly placed and revised VP shunts were subject to Kaplan-Meier analysis, and 30-day failure rate was obtained. Data from 2 RCTs investigating new VP shunt technology were analyzed, and the 30-day failure rate was extracted for comparative purposes.
  
  
  RESULTS
  The overall 30-day and 1-year failure rates for new shunts were 12.9% and 28.8%, respectively. The 30-day failure rate from 2 RCTs was comparable (14% and 16%, respectively). The failure rate of the subsequent revision of those new shunts was 20.7% at 30 days and 40.4% at 1 year. According to these data, shunt survival appears to be better if performed by a consultant pediatric neurosurgeon for revision surgery only.
  
  
  CONCLUSIONS
  VP shunt survival in the UK is comparable to the published multicenter data investigating shunt survival. The 30-day failure rate may represent a better barometer of surgical outcome and should be used as a separate outcome measure in the design of future trials.
authors.affiliation: *Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom; ‡Department of Neurosurgery, Children's University Hospital, Dublin, Ireland; §Department of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada; ¶Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; ‖Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom; #Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, United Kingdom; **Department of Neurosurgery, Royal Manchester Children's Hospital, Manchester, United Kingdom.
authors.forename: Yahia Z
authors.initials: YZ
authors.lastname: Al-Tamimi
authors.forename: Priyank
authors.initials: P
authors.lastname: Sinha
authors.forename: Paul D
authors.initials: PD
authors.lastname: Chumas
authors.forename: Darach
authors.initials: D
authors.lastname: Crimmins
authors.forename: James
authors.initials: J
authors.lastname: Drake
authors.forename: John
authors.initials: J
authors.lastname: Kestle
authors.forename: Richard
authors.initials: R
authors.lastname: Hayward
authors.forename: Guirish A
authors.initials: GA
authors.lastname: Solanki
authors.forename: Simon
authors.initials: S
authors.lastname: Thomson
authors.forename: John
authors.initials: J
authors.lastname: Thorne
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009493:Neurosurgery / Q000592:standards; D010372:Pediatrics / Q000592:standards; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D006113:United Kingdom; D017287:Ventriculoperitoneal Shunt